Professional Practice Environment Research Articles

The Voice of Travel Nurses: Facilitating Effective Staffing During Pandemic and Expansion-Related Demands in a Children's Hospital.

The aim of this study was to explore the experience and perceived value of travel nurses in a children's hospital. Children's hospitals face unique challenges related to highly specialized care requirements and workforce expansion limitations. Travel nurses can augment nurse staffing capacity during times of intense demand and may offer insights as organizations seek to strengthen work environments. Pediatric travel nurses currently contracted at the hospital were invited to participate in a focus group or interview. Content analysis was used to summarize information and identify themes. From the 56 participants, 5 themes emerged. The themes were financial, flexibility, searching for healthy work environments, nursing care, and solutions. Hearing the voices of travel nurses may offer valuable feedback to strengthen future professional practice environments.

Validation study of the Amharic version Safety Attitudes Questionnaire (SAQ) in public hospitals of Addis Ababa, Ethiopia: a cross-sectional study

BackgroundIn Ethiopia, there is a growing concern about improving patients’ safety in healthcare facilities. However, the lack of a valid and reliable instrument sensitive to the Ethiopian culture for measuring health professional practice environment leads to difficulty in constructing evaluations of safety climate and further linking organizational research to outcomes research. This research study examined the psychometric properties of the Safety Attitude Questionnaire (SAQ) in the Amharic language within an Ethiopian healthcare context.MethodA hospital-based cross-sectional study design was conducted. The SAQ was meticulously translated into Amharic using forward and backward translation methods. Content validity was evaluated with input from seven patient safety and healthcare quality experts. Face validity was established through feedback from healthcare professionals. Then, the Amharic SAQ (SAQ-A) was distributed to 648 participants working in 11 public hospitals, and a total of 611 valid questionnaires were completed and returned (95.2% response rate). Cronbach’s alpha, McDonald’s omega, composite reliability, correlation analysis, and average variance estimation were calculated, and confirmatory factor analysis was performed. Descriptive analyses were performed to describe socio-demographic characteristics. A P-value of ≤0.05 was considered statistically significant. Tables, figures, charts, and texts are used for data presentation.ResultThe overall internal consistency (Cronbach’s alpha) for the 31-item SAQ-A was 0.903, indicating excellent reliability. Confirmatory factor analyses demonstrated a good model fit for each dimension and the entire construct (χ2=1086.675, df=412, p<0.001, comparative fit index (CFI)=0.923, Tucker Lewis index (TLI)=0.913, and root mean square error of approximation (RMSEA)=0.052). The positive response rate of healthcare workers in hospitals was 32.1%. The positive response rates of the six dimensions were teamwork climate (59.7%), safety climate (41.9%), job satisfaction (57.1%), working conditions (37.5%), perception of management (37.6%), and stress recognition (46.2%).ConclusionThe Amharic translation of the SAQ showed good psychometric properties, making it a valuable tool for assessing safety attitudes among Amharic-speaking Ethiopian healthcare practitioners.

Nurses' Perceptions of Caring at Work: Mixed-Methods Study, Quantitative Report.

Study objectives were to explore nurses' perceptions of self-care, co-worker, and leader caring within healthcare work environments and assess reliability of 3 Watson Caritas Scores. Assessing caring in an organization where Watson's Theory of Human Caring guides nursing practice offers insight into the professional practice environment. This study reports quantitative data from mixed-methods descriptive, cross-sectional survey of 1307 RNs at a large healthcare system. Mean scores were self = 5.46, co-worker = 5.39, and leader score = 5.53, and median scores were >5.6 (range, 1-7). All scales had a positive and significant correlation to likelihood to recommend the organization, with the largest being feeling cared for by leaders. Internal reliability of the 3 scales was ≥0.9. Nurse perceptions of caring may influence the organization's reputation. Assessing the perception of caring among nursing staff after the introduction and enculturation of this framework is needed. Results support psychometric value for 3 Watson Caritas Scores.

Structural Equation Modeling of Associations Between Nursing Practice Environment And Missed Nursing Care: A Cross-sectional Study.

Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic. To determine the relationship between the NPE and MNC during the COVID-19 pandemic. A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling. The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care , effective leadership , and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively. The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE.

The Relationship between Clinical Environment and Adverse Events Reporting: Evidence from Lithuania.

The clinical environment plays a crucial role in patient safety, as it encompasses the physical, organizational, and cultural aspects of healthcare delivery. Adverse events, such as active errors, can often be attributed to systemic issues within the clinical environment. Addressing and improving environmental factors is essential for minimizing adverse events and enhancing overall patient care quality. A descriptive, cross-sectional design was applied. The study utilized two questionnaires: the Reporting of Clinical Adverse Events Scale (RoCAES) and the Revised Professional Practice Environment (RPPE) scale. A total of 1388 questionnaires were fully filled out, with a response rate of 71 percent. Nurses who expressed higher levels of satisfaction with various aspects of the clinical environment were more inclined to indicate their intention to report adverse events in the future. These positive relationships suggest that a contented clinical environment fosters a greater willingness among nurses to report adverse event occurrences. The findings of our study support the evidence that demonstrated that the clinical environment plays a significant role in influencing the reporting of adverse events in healthcare settings. It significantly influences nurses' attitudes, quality of care, and adverse event reporting rate.

Exploring Professional Practice Environments and Organisational Context Factors Affecting Nurses' Adoption of Evidence-Based Practice: A Scoping Review.

This scoping review, conducted within the Joanna Briggs Institute (JBI) framework, analysed the recent literature (January 2018 to March 2023) addressing factors inherent to professional practice environments and organisational contexts influencing nurses' adoption of evidence-based practice (EBP). This review included studies involving nurses regardless of sector, practice setting, and scope of practice. A systematic search was undertaken across the PubMed, Web of Science, CINAHL, and MEDLINE databases, as well as the EThOS, OATD, and RCAAP platforms. The extracted textual elements underwent a content analysis, resulting in a coding structure established through an inductive approach that categorised information into main categories and subcategories linked by similarity and thematic affinity. Forty-one studies were included, revealing four main categories of factors impacting EBP adoption by nurses: (1) organisational dynamics, (2) management and leadership, (3) teamwork and communication, and (4) resources and infrastructure. The study's limitations acknowledge the subjective nature of categorisation, recognising potential variations based on individual perspectives despite adopting procedures to minimise the risk of bias. The results provide a substantial foundation for developing interventions to cultivate environments conducive to EBP adoption by nurses, thereby enhancing the integration of evidence into nurses' professional practice contexts. This review was prospectively registered on the Open Science Framework (registration no. osf.io/e86qz).

Satisfacción de los pacientes con los cuidados enfermeros en una Unidad de Cuidados Intensivos medida a través de la escala Nursing Intensive-Care Satisfaction-Scale (NICSS)

BackgroundPatient satisfaction in relation with nursing care has become a key determinant of the quality of hospital care. ObjectivesTo evaluate patient satisfaction in relation with nursing care in a critical care context; to determine the correlation between critical patient satisfaction and sociodemographic and clinical variables and to describe patient perceptions with nursing care. MethodsA descriptive, prospective, correlational study which includes the analysis of some open questions in the intensive care unit (ICU) of a tertiary level university hospital. The degree of satisfaction of all patients discharged from de ICU was evaluated. It was used the validated Spanish version of Nursing Intensive-Care Satisfaction-Scale (NICSS). There were also collected sociodemographic and clinical data and 3 open questions were asked. It was used the inferential and descriptive statistics considering statistically significant P<.05. Open questions were examined using a language context analysis. The approval of the hospital ethical committee was obtained. Results111 patients agreed to participate, with a mean age of 64,18 years (CI 95% 61,36-66,88) and with a medium level of satisfaction of 5,83 (CI 95% 5,78-5,88) being 6 the maximum score. Women, older patients and those who reflect a higher degree of recovery, are those who reported greater satisfaction. Three main themes emerged from the analysis of the open-ended questions of the surveys: nurse patient relationship, professional practice environment and ICU nature. ConclusionPatient satisfaction in relation with nursing care was elevated. Age, sex and degree of recovery significantly influenced their perception. Nurse patient relationship and the professional practice environment were aspects highlighted by patients. The professional model incorporated by the institution may encouraged these results.

Professional Nursing Practice Environment and Work Engagement: The Mediating Roles of Self-Efficacy and Achievement Motivation.

The shortage of nurses is a global problem. Increasing the level of work engagement is known to effectively reduce turnover rate among nursing staff. Strategies to improve work engagement based on the job demands-resources model may effectively improve nurses' job satisfaction and reduce staff turnover. A job demands-resources model was used in this study to test the hypothesis that work engagement is affected by both external resources (professional nursing practice environment) and internal resources (self-efficacy and achievement motivation). In addition, the mediating role of self-efficacy and achievement motivation in the relationship between professional nursing practice environment and work engagement was also verified. A cross-sectional survey employing a convenience sampling design was implemented. Five hundred fifteen registered nurses were recruited from four tertiary hospitals in Chengdu, China, from January to June 2020. The Practice Environment Scale of the Nursing Work Index, General Self-Efficacy Scale, Achievement Motive Scale, and Utrecht Work Engagement Scale were used to measure the four variables. The results of the structural equation model showed that the degree of fit for each index model was good, indicating that all of the three variables, including professional nursing practice environment, self-efficacy, and achievement motivation, directly affected work engagement. In addition, the variable professional nursing practice environment was found to indirectly influence work engagement through the partial mediation of self-efficacy and achievement motivation. The results may be used to guide health policymakers and nurse managers attempting to enhance the work engagement of nurses by providing a supportive working environment, improving the welfare mechanism, formulating a talent training plan, and fostering appropriate empowerment to improve the working environment, self-efficacy, and motivation in nurses.

The impact of nursing practice environments on patient safety culture in primary health care: a scoping review protocol.

Patient safety is a key priority for healthcare organisations. It impacts directly on patient health and wellbeing. The increasing complexity of current healthcare settings, which are associated with high work demands and increasingly stressful professional practice environments, contributes to an increased likelihood of errors and adverse events. Primary health care, given its comprehensiveness of care, makes up a large proportion of the care delivered to the population. To map the knowledge about the impact that nursing practice environments have on safety culture in the primary healthcare setting. This knowledge is essential for a more effective and appropriate understanding of this phenomenon and to enable the definition of strategies that can promote the provision of safer care to the population. A scoping review will be conducted based on the method proposed by the JBI, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used. Study selection, data extraction, and synthesis will be performed by two independent reviewers. Based on the Population (or participants), Concept, and Context (PCC) framework, this scoping review will consider studies that address nurses' practice environment and patient safety culture in primary health care. The review will consider all studies, published or unpublished, from 2002 to the present. The results from this scoping review are expected to provide an overview of the importance of the nursing practice environments on patient safety culture, which will be crucial to define an appropriate range of strategies to promote the delivery of the safest health care to the population.

MP57-07 PATTERNS AND IMPACT OF BURNOUT AMONG WOMEN IN THE UROLOGY WORKFORCE

You have accessJournal of UrologyCME1 Apr 2023MP57-07 PATTERNS AND IMPACT OF BURNOUT AMONG WOMEN IN THE UROLOGY WORKFORCE Shree Agrawal-Patel, Erin Kim, Shelby Harper, Lourdes Guerrios-Rivera, M. Francesca Monn, Janae Preece, Arshia Sandozi, Akanksha Mehta, Anna Zampini, and Smita DE Shree Agrawal-PatelShree Agrawal-Patel More articles by this author , Erin KimErin Kim More articles by this author , Shelby HarperShelby Harper More articles by this author , Lourdes Guerrios-RiveraLourdes Guerrios-Rivera More articles by this author , M. Francesca MonnM. Francesca Monn More articles by this author , Janae PreeceJanae Preece More articles by this author , Arshia SandoziArshia Sandozi More articles by this author , Akanksha MehtaAkanksha Mehta More articles by this author , Anna ZampiniAnna Zampini More articles by this author , and Smita DESmita DE More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Contemporary rates of burnout amongst urologists are reported to be 60-80%. These rates have significant implications on physician well-being and retention. We investigated predictors of burnout in female surgeons. METHODS: An electronic census survey was distributed to residents, fellows and practicing urologists by the Society of Women in Urology in the United States and territories via email and social media between February and May 2022. We assessed participant demographics, personal and professional characteristics, practice environment, compensation, and burnout with chi-square and t-test analyses. RESULTS: There were 379 survey participants with an average age of 42 years (SD 10). A majority identified as cis-gendered heterosexual females (96%) and were practicing urologists (74%), while 10% were fellows and 15% residents/interns. Average reported time in practice was 9 years (SD 9 years). Most respondents reported burnout (273, 72%), with 87% agreeing COVID worsened burnout in the community. Those reporting burnout worked an average of 58 (SD 15) hours per week versus 49 (SD 18) hours (p<0.00001). Table 1 demonstrates significant personal and professional characteristics for participants who reported burnout. On multivariable logistic regression analysis, increased hours worked per week (OR 1.03, p=0.002), Relative Value Unit based pay versus salary (OR 4.4, p=0.007), correlated to burnout and feeling income is comparable to peers (OR 0.4, p=0.03) was inversely related. Common shared experiences included lack of staffing, reduced operating room time, lack of administrative support, predominance of non-operative referrals, gender and racial inequity or microaggressions, electronic health records with increased documentation demands, increased non-clinical administrative duties, and insufficient compensation or lack of financial advancement. CONCLUSIONS: A majority of women in urology report burnout with work-hours and compensation inequity as leading contributing factors. Concerns raised in this study such as lack of support staff, racial and gender inequity, and poor referral patterns should be further evaluated to determine a comprehensive plan to reduce burnout. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e786 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shree Agrawal-Patel More articles by this author Erin Kim More articles by this author Shelby Harper More articles by this author Lourdes Guerrios-Rivera More articles by this author M. Francesca Monn More articles by this author Janae Preece More articles by this author Arshia Sandozi More articles by this author Akanksha Mehta More articles by this author Anna Zampini More articles by this author Smita DE More articles by this author Expand All Advertisement PDF downloadLoading ...

Missed Nursing Care and its relationship with Nurses’ Perceptions of Professional Practice Environment during Hajj Season

Context: An important factor that significantly affects missed nursing care is the nursing work environment. Additionally, it significantly impacts the recruitment and retention of healthcare professionals and indirectly affects the standard of nursing care.&#x0D; Aim: To identify nurses' perception of the professional practice environment, identify types and reasons for missed nursing care, and find the relationship between nurses' perceptions of the professional practice environment and missed nursing care during the Hajj season.&#x0D; Methods: A descriptive correlational design was carried out at seven hospitals in Makkah region. A convenience sample of 463 registered nurse who has at least one year of nursing experience and working in inpatient units was included in this study. Data was collected through an online questionnaire. It included patients' demographic data, the revised professional practice environment scale, and missed nursing care assessment questionnaire.&#x0D; Results: The result of this study reveal that the mean scores of the professional practice environment and its subscales were 3.56±0.46, indicating a favorable environment. Furthermore, it was found that the overall missed nursing care among the studied nurses was 1.56±0.65, which indicates low missed nursing care. The highest reason for missed nursing care was the inadequate staff (2.85±1.12), supplies/equipment not functioning properly when needed (2.74±1.07), and not being available when needed (2.70±1.10). The professional practice environment statistically significantly negatively correlated with missed nursing care (r=-0.32, p=0.000).&#x0D; Conclusion: Missed nursing care in hospitals can be reduced by improving the professional practice environment. The study recommends that the hospital and nursing administrators consider keeping good practice environments for nurses to prevent missed care activities and potentially enhance patient outcomes in nursing units.

Analysis of the Work Environment and Burnout among Nurses, Technicians and Nursing Assistants in Brazilian Institutions

In addition to causing damage to the health of patients, the Covid 19 pandemic has brought a greater burden to health systems directly affecting professionals, leading many to physical and emotional exhaustion. The present study aims to demonstrate the perceptions of the professional practice environment of nurses, technicians and nursing assistants through the use of the Environment of Professional Practice research (Practice Environment Scale of the Nursing Work Index – PES/NWI) and the Maslach Burnout Inventory (MBI), in addition to comparing them. The researches were applied in private and public administrative institutions in four Brazilian states, these being Amazonas (AM), Minas Gerais (MG), Mato Grosso do Sul (MS) and Rio de Janeiro (RJ) that are part of the IQG Nursing Certification, from December 2020 to June 2021, with the participation of 1484 professionals from the six invited institutions. The nursing team-physician relationships are identified as the most favorable characteristics of the work environment in the PES/NWI, and the foundations for nursing practice, however, identified as unfavorable to the participation of nursing in hospital affairs and adequacy of personnel and resources. Regarding the dimensions of the MBI research the best results are related to emotional exhaustion. However, the rates of low professional fulfillment were 69.1%. There are impacts on burnout related to emotional exhaustion and professional fulfillment related to the work environment, more frequently in the group of nurses. The analysis showed differences in the perceptions of nurses when compared to nursing assistants and technicians, with attention to inter-professional working relationships and the availability of resources. Therefore, the importance of guiding actions aimed at the management of these health resources is portrayed, with attention to the risk to the quality and safety of care, but also to the health of these professionals. The role of the leader, represented by the nurse, needs more attention and preparation, given its potential in guiding the best practices, professional engagement and promoting changes in the environment of professional practice.

Reflection as creative practice: an exploration of arts-based practice workshops with student midwives

Educators must use diverse tools to facilitate effective student learning, enabling students to translate taught theory into the professional practice environment. Reflection is an essential midwifery skill that is needed to practice effectively, and is often taught by exploring a variety of reflective models in a written format during undergraduate healthcare programmes. This article reports and evaluates the activities and experiences of facilitating innovative arts-based practice workshops using collage for student midwives and how they felt this contributed to their ability to successfully reflect. The article explores undertaking the art of reflection as a creative practice from both a lecturing and learning perspective, to explore student midwives' reflective abilities using alternative methods to the written word. Combining arts and science in a safe educational space provided students with an alternative way to view and explore their practice learning and reflection by using a holistic range of skills.

Privileging for Nursing: Structural Requisites for Next-Step Professional Governance

Structuring for the profession of nursing in any practice setting is critical to the expression of professional practice behaviors. Explored here is a brief outline of what a nursing professional privileging structure might look like and how it replaces historic "job-based" approaches as a better way of addressing nurses and their practice in a professional practice environment.

Predictors of organizational commitment among Chinese nurses during the COVID-19 pandemic.

AimTo investigate organizational commitment among Chinese nurses and analyze factors influencing organizational commitment during COVID‐19.BackgroundOrganizational commitment is the most important link between nurses and the organization because it is effective in work retention and the motivation of nurses, especially when addressing the COVID‐19 crisis. However, there has been no empirical study conducted to predict organizational commitment in the field of nursing by combining work values with professional practice environments.MethodsA cross‐sectional predictive study was done with 362 nurses recruited from two tertiary hospitals in China. The Organizational Commitment Questionnaire, the Work Values Scale, and the Practice Environment Scale of the Nursing Work Index were used to collect data. Two factors related to the organizational commitment of nurses were investigated by using binary logistic regression analyses.ResultsIncreased work values and a professional practice environment were associated with an increased likelihood of higher organizational commitment.DiscussionThe COVID‐19 crisis became the utmost challenge to global healthcare systems and professional organizational commitment. Nurses’ organizational commitment was directly influenced by the professional practice environment and work values, especially intrinsic work values, in which the spirit of collectivism was consequential.Conclusion and implications for the field of nursing and health policyStudy results provide information for global hospital administrators to promote these organizational commitment predictive factors, including work values and a professional practice environment in nursing practice. This helped foster a stronger organizational commitment among nurses to reduce nurse resource flow during COVID‐19.

Forensic mental health: Perceptions of transition and workforce experiences of nurses

<h2>ABSTRACT</h2><h3>Background</h3> With the growing need for nurses in forensic mental health settings, understanding the experiences of transition and perceptions of the setting is important to support staff retention. <h3>Aim</h3> To explore registered nurses' experiences of working in a forensic mental health setting. In particular, to understand their transition experience, perceptions of the practice environment and intention to stay within the setting. <h3>Methods</h3> Registered nurses employed in a high-secure forensic mental health hospital in New South Wales, Australia, completed an online survey including the Revised Professional Practice Environment Scale and Nurse Retention Index. <h3>Findings</h3> Sixty-nine participants responded to the survey. During the first year of their employment, participants reported feeling isolated, lacking support and being anxious when providing patient care. In terms of the environment, participants perceived ‘internal work motivation' as positive in the environment when compared to ‘handling disagreement and conflict'. While many intended to continue their nursing careers for the foreseeable future, 45.3% of participants were undecided about whether they would leave the forensic setting. <h3>Discussion</h3> Due to the complexity of forensic mental health practice, the reporting of poor experiences of transition and issues regarding support and conflict is concerning. Considering the importance of workplace culture and teamwork in forensic mental health, strategies to enhance positive interpersonal relationships is essential. <h3>Conclusion</h3> Given the predicted future workforce shortages, this study highlights a need for appropriate supports for nurses' transitioning into forensic mental health employment to enhance workplace satisfaction and retention.

The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals.

Identify and examine drivers of nurse manager competency and high-quality practice environments. Nurse managers are a key predictor of positive professional practice environments, which are, in turn, associated with nurse, patient, and organisational outcomes. However, little work has examined the factors that contribute to nurse manager competency. Nurse managers completed online surveys, which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency. Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education. Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education. Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.

Impact of COVID-19 on professional nursing practice environments and patient safety culture.

AimTo analyse the impact of COVID‐19 on professional nursing practice environments and patient safety culture.BackgroundThe relationship between work environments and patient safety has been internationally recognized. In 2020, the pandemic imposed enormous challenges, yet the impact on these variables remains unknown.MethodThis is a quantitative observational study, conducted in a Portuguese hospital, with 403 registered nurses. A self‐completion questionnaire was used.ResultsThe impact on the Structure and Outcome components of nursing professional practice environments was positive. Although the Process component remained favourable to quality of care, a negative trend was confirmed in almost all dimensions. The results regarding safety culture showed weaknesses; ‘teamwork within units’ was the only dimension that maintained a positive culture.ConclusionPositive responses regarding patient safety were significantly associated with the quality of the nursing professional practice environment. The need to invest in all dimensions of safety culture emerges to promote positive professional environments.Implications for nursing managementImproving professional nursing practice environments can be achieved through managers' investment in the participation and involvement of nurses in the policies and functioning of institutions, as well as promoting an open, fair and participatory safety culture that encourages reporting events and provides adequate support for professionals.

Examination of Factors Affecting Therapeutic Attitude and Empowerment of Perianesthesia Nurses Who Care for Patients With Opioid Use Disorder

Patients with opioid use disorder (OUD) and associated complexities are presenting to hospitals in increasing numbers. Preparation of perianesthesia nurses caring for this patient population has lagged, with noted deficits in continuing education, resources, and role support. Previous research found education without considering therapeutic attitude (TA), empowerment and factors that influence nursing practice does not translate into feelings of competence in nursing care. The purpose of this study was to identify correlates and predictors that affect TA and empowerment among perianesthesia nurses caring for patients with OUD. A cross-sectional, correlation design was used to identify correlates and predictors of TA and empowerment in a national sample of perianesthesia nurses (N=215) METHODS: A national survey collected data from perianesthesia nurses. The Perianesthesia Nurse Empowerment and Therapeutic Attitude Model was the guiding framework. Pearson product-moment correlation and hierarchical multiple regression analyses were used to examine relationships between personal factors, the professional practice environment and societal factors of perianesthesia nurses. The standardized regression coefficients indicated the professional practice environment (β=-0.28), drug user stigma (β=0.27), access to a pain specialist (β=0.25), and exposure to drug users (β=0.25) were the strongest predictors of TA. Access to a pain specialist (β=-0.15) and the professional practice environment (β=0.72) were the strongest predictors of empowerment. The professional practice environment directly influenced the degree of empowerment and TA reported by perianesthesia nurses. Exposure to persons with OUD and personal stigmatization of persons who misuse drugs decreased TA but had no association with empowerment. Access to a pain specialist was moderately predictive of empowerment and negatively associated with TA suggesting a lack of role legitimacy and the need for further research into perianesthesia nurses' perceptions of their role when caring for this population.

Impacts of Nursing Work Environment on Turnover Intentions: The Mediating Role of Burnout in Ghana

Background The nursing practice environment supports excellence and decent work and has the influence to entice and retain the quality nursing workforce. Appreciating the dynamics that affect the turnover intention of RNs offer reasonable solutions to the challenges of the nursing shortage, which directly influence the quality of nursing care. There is a paucity of information on the impacts of these concepts among RNs in Sub-Saharan African. The study therefore aimed at determining the impacts of work environment and burnout on turnover intentions among RNs in Ghana. Methods A descriptive cross-sectional design using a simple random and proportionate stratified sampling with a sample of 232 RNs from Municipal and Regional Hospitals, Sunyani, West-Central part of Ghana completed validated instruments measuring work environment, burnout, and turnover intentions. Descriptive analysis was done to find out RNs' perceptions of their work environment and turnover intentions. Mediation analysis by Baron and Kenny's approach was used to determine the mediating effect of burnout on the relationship between the domains of PPE and the turnover intention of RNs. STROBE checklist was used as the reporting tool. Results While most RNs had a positive perception about their work environment, greater number of them had turnover intentions. There were significant associations between some nursing work environment facets and turnover intention. The results also showed a statistically significant relationship between nurse-physician relation (β = .353, t = 5.476, p ≤ .001), nurse manager leadership (β = −0.485, t = −8.192, p ≤ .001), nursing foundation for quality care (β = .400, t = 7.059, p ≤ .001), staffing and resource adequacy on (β = 0.485, t = 8.183, p ≤ .001), and turnover intention as mediated by burnout. Conclusion Burnout resulting from an unsafe work environment impact RNs' turnover intention. This phenomenon can potentially affect the human resource management and quality of nursing care. Policy strategies aimed at ensuring a professional practice environment and decreased burnout can therefore improve retention of RNs at their workplace.